2005, 03-23 Permit App: 05000880 RemodelProject Number: 05000880 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: 2 -STORY RES REMODEL -3 BEDRMS, 2 BATHS, Contact: TOLIVER, DALE
LAUNDRY & SITTING RM Address: 43 E 28TH AVE
C - S Z: SPOKANE, WA 99203
Setbacks: Front Left: Right: Rear: Phone: (509) 389-2333
Group Name:
Project Name:
Site Information:
Plat Key: 001839 Name: OPPORTUNITY TR # 01-354 District: Sout
Date: 03/23/2005 Page 1 of 3
Parcel Number: 45212.1606 Block: Lot:
SiteAddress: 612 S BOWDISH RD
Location:: CSV
Zoning: UNKN Unknown
Water District:
Area: .00 Acres
Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Review
Plan Review
Sewer Review
Permits:
Owner: Name: TOLIVER, DALE
Address: 43 E 28TH AVE
SPOKANE, WA 99203
Hold: El
Depth: 0 Right Of Way (ft): 0
Released By.
•
Operator: K_C Printed By: K_C Print Date: 03/23/2005
Project Number: 05000880 Inv: 1
r
Application
Date: 03/23/2005 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
CONNECTION TO COUNTY SEWER REQUIRED PRIOR TO RELEASE OF ANY
BUILDING/PLUMBING/MECHANICAL PERMITS. 7/9/98 JDL
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Fee Amount Invoice Amount Amount Paid Amount Owing
$356.25
$54.00
$60.00
$356.25
$54.00
$60.00
$0.00
$0.00
$0.00
$356.25
$54.00
$60.00
$470.25 $470.25 $0.00 $470.25
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 03/23/2005
BUILDING PERMIT APPLICATION WORKSHEET
ane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
SITE INFORMATION
Street Address: .te _• (--.)/1) k.5
Assessor's Tax Parcel Number(s): *52 12 -
Legal Description: t)i 'i--) 3'i Ji -v-/ ) i /-7; :1_ (7) 1-1 _ 2 1; J
PERMIT DESCRIPTION: e '- 4,04., 'p.1- Z A64 /1 eti- i-enwilf/1.1-4,4 tws,44,-fs cold
fre-,es..? deer7e i4,4115 e'''",; 1.--`7-‘16A--' xi'. l'-1 .1.4.0
El Building Permit F Change in Use [-I Grading 0 Manufactured Home
P Relocation -1 Tenant Improvement P Fire Safety Other
OWNER/APPLICANT INFORMATION
Owner: DA LE --I L jJt
Phone: it/ -2.33 3 Fax:
Address: v3
Ci
Contractor:
State
Zip Code
Phone: Fax:
Address:
City
State
Zip Code
WA State Contractor License #:
0 Applicant:
Phone:
Address:
City
0 Architect:
Phone:
State Zip Code
Address:
Fax:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
2- 2 --
DIMENSIONS:
# OF STORIES: / /
MAIN FLOOR TO SQ. FTG:
2N0 FLOOR SQ. FTG:
o
UNFIN BASEMENT SQ. FTG:
9Y0
FINISHED BASEMENT SQ. FTG:
..y
GARAGE SO. FTG:
iltic,
DECK/COV. P90 SQ, FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
_f- k /-=-fr-4.-e
HEAT SOURCE; 4-, I,/ 121
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT.,,
Pi A
30% SLOPES ON PROPERTY:
4 pel
SEWER OR ON -SIT TI
SYSTEM? V.e<
77/19 -Pi‘ 501r1"7"'"
MANUFACTURED HOME
Width:
Manufacturer:
Length:
Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone:
Fax:
City
Phone:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING (1 CONCRETE
Firm Name:
n REINFORCEMENT
Phone:
Inspector(s):
Fax:
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the_dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner.- 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit in o the property o
Print Name I_
V' i_
I i \. t=i
Signature 7 .; 2 i L
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
El Cash
Bankcard #:
❑ Check ❑ Mastercard
Authorized Signature:
VISA ❑ Other
Expires: VIN#:
Project Address:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
// H-- Permit Use:
Owner: 2)6 , 47. (
Mailing Address: cj;:, e 'z
Community Development Departmen
Building Divisior
11707 E. Sprague Avenue, Suite 1DE
Spokane Valley, WA 9920E
• ;
Phone
Phone (Daytime C act): -3i
-
City
Contractor: License #:
Mailing Address:
c
State
Zip Code
Phone #:
State
Zip Code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
1
X
$t2.00
=
) 2.
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
=
3
UNLISTED APPLIANCE (Additional Fee) .
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00
=
-
8
USED APPLLANCE (WSEC min. AFUE rating)
More than 400,000
X '
S100,00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.00
=
9
BOILER/REFRIGEFtATION
501 - 1,000M BTU '
X
$25.00
1
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
.
X
- $10.00
=
13
RANGE
-X
$10.00
-
14
DRYER
X
$10.00
=
•
15
FUEL BURNING WATER HEATER
X
$10.00
=
'
16 ,
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
$1,00
=
18
DUCT SYSTEMS
X
$10.00
=
..
19
VENTILATING FANS
.
X
$10.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
-,)-- .
X
$12.00
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
-
24
TYPE II HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
'
X
$1200
=
26
. AIR CONDITJONER .
3-15 TON
X
$20.00
.=
27
.
AIR CONDITIONER15-30
TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
-
29
AIR CONDITIONER
More than 50 TON
X
$60.00
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
'X
$10.00
32
WOOD STOVE - FREE STANDING
X
825.00
33
REPAIR & AMMONS
. -
'
X
$15.00
=
34
VENTILATION SYSTEMS
X
' $12.00
=
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
=
36
INCINERATOR - RESIDENCE :?
X
$19.00 '
37
INCINERATOR - COMMERCIAL
X
$22.00
=
.
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD t:
DATE:
SUBTOTAL
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Community Development Department
Building DivisiOn
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Project Address: ((' Ill . _ :' - V )/:‘, / Permit Use: . C., x 7,)/4.-' --v, 2,.-
Owner: ) /. L i - 1 I '4.,7 Phone (Daytime Con/tact): /
Mailing Address: 4_/..:-; r
State
Contractor:
Cit
License #:
Zip Code
Phone #:
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK •
* OF UNITS
X
, COST .
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS '
-
X
36,00
=
/ 2,_ . •
2
URINALS
X
36.00
=
3
TUBS .
-
2 -
X
36.00
=
• I 2_
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
0"5 -.
X
36.00
=
/ 2_
•
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
36.00
=
/
6
DISHWASHER
4
X
36.00
=
7
CLOTHES WASHER
i
X36.00
--
(4'
8
GARBAGE DISPOSAL "
X
36.00
9
WATER SOFTENER
X
$6 00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
.
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
...
$6.00
=
-
12
'ROOF DRAINS/OVERFLOW
DRAINS
X
36.00
=
13
FOUNTAINS, DRINKING
X
36.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
. REVERSALS
1
X
36.00
=
.,
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
,
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
36.00
=
17
•
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS BOILERS
X
36.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
36.00
=
-
20
MISCELLANEOUS PLUMBING
FLXTURE
.
X
36.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
320.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
315.00
=
_
METHOD OF PAYMENT:
0 CASH 0 CHECK VISA Q MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
;
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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